Videoconference Request Form

Videoconference Request Form - SIU School of Medicine (revised 5/4/07)

Videoconference reservations will be made no more than one year in advance
You MUST reserve your meeting rooms BEFORE requesting a videoconference.

Room reservation information. (SIU-SM network access only)

Use this form to request a videoconferencing connection for:

a one-time meeting
6 (max) recurring meetings (same start time, end time, and locations) - otherwise use separate forms.

You will receive confirmation numbers when your request has been reviewed and scheduled.
Additional videoconferencing information See "Videoconference" (SIU-SM network access only)

RED (required) - BLUE (provide details if applicable)

Meeting Name:
Meeting Purpose:

Requested by:	The requester is responsible for notifying all meeting attendees. List alternate contact in NOTES section.
Requester Phone #:	(ex.333-333-3333)
Requester Email:	ONE email address only

Meeting Times - automatically connected sessions will connect and disconnect at these times. Plan accordingly.

Start Time: use military time (4 digits, no ":")

End Time:

Videoconference reservations will be made no more than one year in advance. (date format mm/dd/yyyy)

Meeting Date 1:

Meeting Date 2:

Meeting Date 3:

Meeting Date 4:

Meeting Date 5:

Meeting Date 6:

Reserved Meeting Rooms: If "New Location" or "Other" is selected or if more than 6 locations are needed, put details in the NOTES section:
You MUST reserve your meeting rooms - Meeting Rooms (SIU-SM network access only)

Select at least TWO locations

Location 1:	# attending:
Location 2:	# attending:
Location 3:	# attending:
Location 4:	# attending:
Location 5:

Meeting Times -	automatically connected sessions will connect and disconnect at these times. Plan accordingly.
Start Time:	use military time (4 digits, no ":")
End Time:

Meeting Date 1:
Meeting Date 2:
Meeting Date 3:
Meeting Date 4:
Meeting Date 5:
Meeting Date 6: